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November 11, 2009
Editor, Heart
British Medical Journal
Dear Sir:
I am writing to comment on the excellent article by Bhaskaran et al in Heart[1], and especially on the editorial by David Newby [2] that commented on this paper. In my opinion, Dr. Newby has missed the most important conclusion of the Bhaskaran paper.
Dr. Newby’s editorial was focused mainly on the cardiac effects of fine particulate pollution, and included a...

November 11, 2009
Editor, Heart
British Medical Journal
Dear Sir:
I am writing to comment on the excellent article by Bhaskaran et al in Heart[1], and especially on the editorial by David Newby [2] that commented on this paper. In my opinion, Dr. Newby has missed the most important conclusion of the Bhaskaran paper.
Dr. Newby’s editorial was focused mainly on the cardiac effects of fine particulate pollution, and included a graph of data from Beijing, China.
However, it seems to me that a far more important contribution of the Bhaskaran paper was the observation of an “ozone protective effect” in several parts of the world. The authors pointed out that this effect is probably due to some pollutant that is negatively correlated with ozone, and cites my previous paper[3] suggesting that the effect could be due to unsuspected methyl nitrite (MN) in the air. This hypothesis has a high degree of plausibility because it is known that MN, unlike ozone, is rapidly destroyed by sunlight and so would be negatively correlated with ozone. To the best of my knowledge, this ozone protective effect is totally inexplicable unless an unknown pollutant, such as MN, is present.
If Dr. Newby’s point of view is to be accepted, then presumably he must argue that fine particulate pollution is also the cause of the ozone protective effect. However, that hypothesis has been thoroughly discredited in another paper [4]. In that paper I showed that fine particulate matter can not explain the negative ozone associations in any parts of the world in which there is published evidence for the negative effects. I particularly showed that explanation is extremely unlikely in Hong Kong, China.
Hence, I feel that the most important contribution of the Bhaskaran paper is to alert the world to the possible existence of a very important toxic pollutant whose presence has escaped attention. Most desperately needed is funding for research to identify MN in engine exhaust. To date, such funding has not been available in the United States.
Sincerely,
Professor Peter M. Joseph, Ph.D.
School of Medicine
University of Pennsylvania
Philadelphia, PA, USA
email = joseph@rad.upenn.edu
REFERENCES
1. Bhaskaran K, Hajat S, Haines A, Herrett E, Wilkinson P, Smeeth L. Effects of air pollution on the incidence of myocardial infarction. Heart 2009;95:1746-1759.
2. Langrish JP, Mills NL, Newby DE. Heat and haze: a forecast for myocardial infarction? Heart 2009;95:1721-1722.
3. Joseph PM. Paradoxical ozone associations could be due to methyl nitrite from combustion of methyl ethers or esters in engine fuels. Environ Int 2007;33:1090-106.
4. Joseph PM. Can fine particulate matter explain the paradoxical ozone associations? Environ Int 2008;34:1185-91.